LHD-BASED HCH Programs by hcj


									LHD-BASED HCH Programs

        David Modersbach
 Alameda County Health Care for the
        Homeless Program
            June 2011
Most HCH programs are Community Health Center-based
              or stand-alone programs.

             330(h) HCH Programs Nation-wide:

26 out of 207 HCHs operate within Public Health Departments
         Why Public Health Departments?
•   Local Government often provides the only real safety-net services to the population.
•   Public Health Department or County-based Heath Program (hospital, )
•   County and City-run clinics: STD, Indigent Care, Public Health, HIV, migrant, etc.
•   County-run Indigent Care = SAFETY NET => Health Reform

•   Communicable Diseases, Epidemiology/Community Data (Homeless Death Review
    ReportSanta Barbara) Dental Health, Behavioral Health, Child & Maternal Health, Prevention,
    Chronic Diseases, Emergency Care, Disaster and Pandemic Response, Immunization, HIV
     –   When carried out cohesively & coherently comprise all of most of a Range of FQHC services
•   Disparities, Populations & Upstream work, Convening Communities
•   Prevention of Chronic Conditions, improving living conditions
•   Early Identification of emerging conditions – mobilization
•   Enforcing public health laws

•   LHD-based array of FQHC services -- Role of HCHs to link them together
 FQHC – 330(h) in the Local Health Department
                        they’re all different, but…

• Must provide required HCH services:
  – Full Range of Primary Care including Specialty Care
    (direct and/or by formal contract)

  – Enabling Services (case management)
  – Plus:
     • Specialty Care/Dental, etc.
     • Mental Health
          – Directly or contracted
     • Substance Abuse
          – Directly or contracted
                         Health Reform

We are all charged with implementing Health Reform
 as passed by Congress in the Affordable Care Act
(it discriminates against un-documented persons = 8% of population?)

State of California has embraced ACA:
-benefits exchanges for health insurance
  Medicaid expansion (1115 Waiver)
             Alameda County:

• One of the most diverse counties in the nation
• 2.7 million persons. 230,000 uninsured
• Fragmented health care system
  – 8 FQHC Clinic Consortium
  – Public Hospital Authority – safety net hospital and
  – Alameda Alliance for Health – County public, not-
    for-profit managed care health plan.
  – Health Department:
     • Public Health, Behavioral Health, EMS, Juvenile Justice,
    Health Reform in Alameda County --- ambitious
   Enroll all in Medicaid by 2014
    –    220% FPL and below
    –    Undocumented persons covered

By 2014, County will enroll 225,000 new persons onto already existing –
   many of those will go into a county nonprofit HMO and network of CHC
   FQHCS. But there are an estimated 38,000 persons who will slip through
   this “safety net.” Due to:

    –    Homelessness and housing precarity
    –    Excluded populations: Prisoners, re-entry, mental health, disabled,
    –    Displaced: Undocumented persons, refugees, domestic violence,
        economic migration

                   38,000 most vulnerable persons – excluded
        Role of Health Department to provide safety-net for the safety-net.
    Alameda County Health Care for the Homeless Program

• Since 1988, part of Alameda County Health Care Services Agency
  (the Health Department) – County Board of Supervisors.
• Located within Public Health Department
• Consumer Advisory Board
• HRSA/BPHC 330(h) grant goes directly to program – “standalone”
• Works with other Health Department programs– Behavioral Health,
  Dental, School-based Wellness Centers, Juvenile justice, public
HCH, FQHC and Homeless access to Primary Care
        Patient-Centered Medical Homes

 • HCHP provides all homeless patients with
   access to full range of FQHC services through:
   – Direct Primary Care and Case Management
     Services (3,500 per year)
   – Contracts with Community Health Clinics (3,000)
   – Subrecipient access to Primary Care & FQHC
     services (3,000)
Alameda County Health Care for the Homeless
Health Department Linkages -- FQHC “Portals”

   Dental Health         Behavioral Health
                                                Medical Services
        Health Dept           Health Dept
                                                    Health Dept

       County Clinic
    System Specialty &                          Reentry Services
       Primary Care
                         Wellness Center

                         Homeless SSI Trust
     Youth Justice +
                         Clinic –Transitional    County Indigent
       Prevention          Medical Home         Health Plan (LIHP)
        Health Dep’t        HCHP-BH-CBO
    Patient Centered Health Homes:
•   Coordinated comprehensive care among clinical team
•   Ongoing relationship between patient and personal physician
•   Clinical practices informed by evidence-based best practices
•   Referrals to community, social support systems
•   Integrated clinical prevention and health promotion efforts
•   Health Information Technology
•   Culturally and linguistically appropriate care
•   Access to care – enabling services, communication

• Etc.
     Community Centered Health Homes:
Active Participation in the factors outside of the health care
        system that affect patient health outcomes

   “THRIVE” model

•   HRSA PIN 99-09: Implementation of Balanced Budget Act Amendment: Defines
    models of Public Health Centers, co-applicant boards
•   HRSA PIN 2010-01: Confirming Public Agency Status under the Health Center
•   HRSA PIN 98-23: Health Center Program Expectations
•   HRSA PIN 2009-02: Specialty Services and Health Centers Scope of Project
•   HRSA PIN 2008-01: Defining Scope of Project and Policy for Requesting Changes

•   Partnerships between Federally Qualified Health Centers and Local Health
    Departments for Engaging in the Development of a Community-Based System of
    Care NACHC – National Association of Community Health Clinics
•   Public Agency Community Health Centers: An Opportunity for Local Health
    Departments NAACHO – National Association of County and City Health Officials
•   Community Centered Health Homes- Bridging the Gap between health services
    and community prevention Prevention Institute 2011

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